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      <h4 class="scenarios"><a href="implementation.html" class="blue">NwHIN 1.0 Portfolio</a> > <a href="scenarios.html" class="blue">Scenarios</a> > <a href="scenario_lri2.html" class="blue">Sharing Lab Results with Another Provider</a></h4>
      <h1 class="testimonials">Sharing Lab Results with Another Provider</h1>
      <h6>An ordering physician sends a continuity of care document and patient&rsquo;s lab results to a specialist:</h6>
      <div class="scenario_center"><p><img src="images/scenario_LRI2.png" alt="S&amp;I Scenarios" title="A flow diagram illustrating the transfer of a continuity of care document and structured lab data from the ordering primary care physician to a hematologist via Direct. The physician sends the properly formatted content to the hematologist's Direct address, which has been verified in the Provider Directory. The message passes through the ordering physician's HISP, where it is encrypted and sent to the hematologist's HISP. The hematologist's HISP then decrypts the message and routes it to the hematologist."/></p></div>
      <p>A patient visits his primary care physician after experiencing low energy levels. The primary care physician sends the patient to a reference lab for blood tests. After the primary care physician receives the lab results report, he determines that his patient should visit a hematologist for more specialized care. Prior to the patient&rsquo;s visit with the hematologist, the primary care physician sends a continuity of care document and the structured lab data to the hematologist via Direct. Later, the primary care physician uses the hematologist&rsquo;s recommendations during a follow-up visit with the patient. </p>
      <div class="mu">
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         <td width="40" align="left" valign="top"> <img src="images/clipboard_check.png" alt="Meaningful Use Objectives" /> </td>
         <td width="15">&nbsp;</td>
        <td valign="middle"><p class="mu"><strong>Meaningful Use Stage 2 Objectives related to the exchange of clinical information: </strong>Incorporate clinical lab-test results into Certified EHR Technology as structured data. <em>(Meaningful Use Menu Set 10 for EPs, Meaningful Use Menu Set 8 for EH/CAHs)</em></p></td></tr></table>
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      <h6>Common workflow steps for this scenario:</h6>
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     <table width="946" border="0" cellspacing="0" cellpadding="0">
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         <td width="40" align="left" valign="top"> <img src="images/scenario_1.png" alt="1" /> </td>
         <td width="15">&nbsp;</td>
         <td width="891" valign="middle">The primary care physician extracts a continuity of care document from his EHR, which has been properly formatted according to the HL7 CDA Release 2 CCD, including using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), Logistical Observation Identifiers names and Codes (LOINC) 2.38, RxNorm, and Systemized Nomenclature of Medical--Clinical Terms (SNOMED-CT) vocabularies. He then authors a Direct message and attaches the relevant structured lab data, which is formatted according to the HL7 v.2.5.1 Laboratory Results Interface Implementation Guide using LOINC 2.38. In order to select the hematologist as the recipient, the primary care physician accesses a search dialogue in the HISP's user interface, which queries a Provider Directory (following the Certificate Discovery for Direct implementation guide) for the right Direct address.</td>
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         <td height="15" align="left" valign="top">&nbsp;</td>
         <td height="15">&nbsp;</td>
         <td height="15" valign="middle">&nbsp;</td>
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         <td width="40" align="left" valign="top"> <img src="images/scenario_2.png" alt="2" /> </td>
         <td width="15">&nbsp;</td>
         <td width="891" valign="middle">When the primary care physician sends the message, it passes through the primary care physician&rsquo;s Health Information Service Provider (HISP), a contracted brokering agent responsible for the management of security and transport for directed exchange. As it passes through the HISP, the message is encrypted using the x.509 Certificate associated with the hematologist&rsquo;s Direct address, and delivered to the hematologist&rsquo;s Direct address in accordance with the Applicability Statement for Secure Health Transport.</td>
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         <td height="15" align="left" valign="top">&nbsp;</td>
         <td height="15">&nbsp;</td>
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         <td width="40" align="left" valign="top"><img src="images/scenario_3.png" alt="3" /> </td>
         <td width="15">&nbsp;</td>
         <td width="891" valign="middle">The hematologist&rsquo;s HISP decrypts the message and routes it to the hematologist.</td>
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         <td height="15" align="left" valign="top">&nbsp;</td>
         <td height="15">&nbsp;</td>
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         <td width="40" align="left" valign="top"><img src="images/scenario_4.png" alt="4" /></td>
         <td width="15">&nbsp;</td>
         <td width="891" valign="middle">The hematologist uses the HISP&rsquo;s user interface to access the lab results report in his Direct inbox.</td>
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      <br />
      <h6>NwHIN 1.0 specifications and resources recommended for scenario:</h6>
      <div class="table_scenario2">
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              <h4 class="scenario2"> Content Structure</h4>
              Guidance that specifies how to structure health information to ensure proper exchange</td>
            <td align="left" valign="middle" bgcolor="#E6E6E6"><ul>
            <li><a href="https://www.hl7.org/implement/standards/product_brief.cfm?product_id=6" target="_new">HL7 CDA Release 2 CCD</a></li>
            <li><a href="http://wiki.siframework.org/file/view/V251_IG_SIF_LABRESULTS_R1_N1_v15_Pilot_Use_Only.pdf" target="_new">HL7 v.2.5.1 Laboratory Results Interface Implementation Guide</a></li>
            </ul></td>
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            <td width="300" align="left" valign="top" bgcolor="#002B54">
              <h4 class="scenario2">Vocabulary &amp; Code Sets</h4>
              Specifications that identify common naming convention necessary for proper health information exchange</td>
            <td align="left" valign="middle" bgcolor="#E6E6E6"><ul>
              <li><a href="http://www.cdc.gov/nchs/icd/icd9cm.htm" target="_new">ICD-9-CM</a></li>
              <li><a href="http://www.nlm.nih.gov/research/umls/rxnorm/" target="_new">RxNorm</a></li>
              <li><a href="http://www.ihtsdo.org/join-us/use-snomed-ct-licenses/" target="_new">Systematized Nomenclature of Medicine--Clinical Terms (SNOMED-CT)</a></li>
               <li><a href="http://loinc.org/" target="_new">Logistical Observation Identifiers names and Codes (LOINC)
2.38</a></li>
            </ul></td>
          </tr>
          <tr>
            <td width="300" align="left" valign="top" bgcolor="#BF311A"><h4 class="scenario2">Transport and Security</h4>
              Mechanisms and processes that safely exchange health information over the Internet</td>
            <td align="left" valign="middle" bgcolor="#E6E6E6"><ul>
              <li><a href="http://wiki.siframework.org/file/view/Certificate Discover for Direct Project Implementation Guide.pdf" target="_new">Certificate Discovery using Domain Name System (DNS) and Lightweight Directory Access Protocol (LDAP)</a></li>
              <li><a href="http://wiki.directproject.org/Applicability+Statement+for+Secure+Health+Transport" target="_new">Applicability Statement for Secure Health Transport</a></li>
              <li><a href="http://tools.ietf.org/html/rfc5280" target="_new">x.509 for Certificates</a></li>
            </ul></td>
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